European Journal of Pediatrics最新文献

{"title":"Osmolality of compounded oral liquids for pediatrics.","authors":"Marine Cavelier, Charles Hervouët, Rémi Varin, Henri Gondé","doi":"10.1007/s00431-025-06080-1","DOIUrl":"https://doi.org/10.1007/s00431-025-06080-1","url":null,"abstract":"<p><p>Compounding oral liquids is a common practice in pediatrics given the scarcity of medications suitable for children. However, compounded products are unlicensed. Their safety, effectiveness and quality are not assessed by regulatory agencies. Then, the assessment of critical characteristics of compounded medications relies on compounding pharmacies. Since the osmolality of oral liquids may contribute to gastrointestinal complications, this study aimed to evaluate the osmolality of compounded oral liquid medications. The osmolality of compounded liquid medications listed in the formulary of our institution was measured. The source of the active pharmaceutical ingredient and the vehicle of each compounded medication were collected. Results showed that 61% of the 28 compounded medications exceeded the recommended threshold of 450 mOsm/kg. The primary determinant of osmolality was found to be the vehicle used in compounding, with commercial vehicles being associated with higher osmolality values. The active pharmaceutical ingredient had minimal influence on the osmolality.</p><p><strong>Conclusion: </strong>These findings underscore the importance of the vehicle in the osmolality of compounded oral liquids. Careful selection of compounding vehicles is required to minimize the risks associated with high-osmolality medications, especially for vulnerable populations such as enterally fed neonates. The systematic assessment of osmolality of compound medication would support the implementation of strategies to mitigate the risks associated with high osmolality and improve the safety of compounded pediatric medications.</p><p><strong>What is known: </strong>• Compounded oral liquid medications are widely used in pediatrics due to the limited availability of commercial pediatric formulations. • High osmolality in liquid oral medications may contribute to adverse effects.</p><p><strong>What is new: </strong>• This study highlighted the significant impact of the compounding vehicle on the osmolality of compounded oral liquid medications. • Careful selection of compounding vehicles is important, especially for vulnerable children.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"252"},"PeriodicalIF":3.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent dizziness among adolescents in Denmark: Trends 1991-2022 and associations with sociodemographic factors, health, and health behaviours.","authors":"Bjørn E Holstein, Mogens Trab Damsgaard, Trine Pagh Pedersen, Mette Rasmussen, Mette Toftager, Katrine Rich Madsen","doi":"10.1007/s00431-025-06076-x","DOIUrl":"10.1007/s00431-025-06076-x","url":null,"abstract":"<p><p>1) to study time trends in the prevalence of recurrent dizziness among adolescents in Denmark 1991-2022, and 2) to examine how dizziness was associated with sociodemographic factors, mental health related factors, health status, and health behaviours in 2022. The study focused on recurrent dizziness, i.e. episodes of dizziness several times a week during the last six months. Data stem from the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study which included 11-, 13- and 15-year-olds from random samples of schools in nine comparable surveys from 1991 to 2022, n = 40,102. We applied multivariate logistic regression analyses in the 2022 dataset (n = 5,737) to examine how dizziness was associated with other factors. In 2022, the prevalence of recurrent dizziness was 14.3% (boys 8.8%, girls 19.7%), significantly higher than the 7.1% in the surveys 1991-2018. The prevalence in 2022 was significantly higher among girls, older students, and students not living with both parents. Dizziness was significantly elevated among students with short sleep duration, who skipped breakfast, used alcohol and tobacco, felt lonely, had low life satisfaction, low self-esteem, were exposed to bullying at school, felt high schoolwork pressure, low school satisfaction, who were underweight, overweight, had poor self-rated health, chronic illness, injuries in the last year, headache, stomachache, backpain, feeling low, irritability/bad temper, nervousness, difficulties falling asleep, and poor/restless sleep.</p><p><strong>Conclusion: </strong>The study suggested that dizziness is a general indicator of not feeling well, run down, or suffering rather than a sign of specific somatic health problems.</p><p><strong>What is known: </strong>• Recurrent dizziness is common among adolescents and may limit daily activities and harm quality of life. • Recurrent dizziness in adolescence may reflect somatic and mental health problems and is strongly associated with headache.</p><p><strong>What is new: </strong>• The prevalence of recurrent dizziness among adolescents in Denmark was stable 1991-2018 and increased steeply from 2018 to 2022. • Recurrent dizziness was strongly associated with poor health behaviours, a broad range of somatic and mental health problems, and exposure to stressors.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"247"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct seasonality and increased respiratory failure in RSV patients < 2 years of age after emergence of SARS-CoV-2: data from the multicentric, prospective PAPI study.","authors":"Jessica Bähre, Matthias Lange, Patrick Salaschek, David Twardella, Stefan Arens, Frank Eberhard, Grit Barten-Neiner, Marcus Panning, Holger Köster, Cordula Körner-Rettberg, Martin Wetzke, Christine Happle","doi":"10.1007/s00431-025-06057-0","DOIUrl":"10.1007/s00431-025-06057-0","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) is a leading cause for global infant morbidity and mortality. The COVID-19 pandemic caused significant shifts in seasonality of RSV, and changes in disease severity have been matter of intense discussion. Between September 2020 and February 2023, the multicentric, prospective PAPI study analyzed rates and phenotypes of hospitalized RSV patients aged ≤ 24 months across three German hospitals. Pseudonymized patient data were analyzed employing Mann-Whitney U and chi-square testing, or one-way ANOVA or Kruskal-Wallis testing when more than two groups were compared. Additionally, RSV cases from seasons 2017/2018-2020/2021 were retrospectively analyzed. After its absence in 2020/2021, RSV returned approximately 2 months earlier than usual in late 2021. Overall duration of the season and patient numbers were comparable to previous seasons, and no significant shifts in age and gender distributions occurred in our cohort. While duration of hospitalization did not differ between the periods before vs. after the emergence of SARS-CoV-2, a significantly higher rate of patients with hypoxemia and respiratory failure occurred after the onset of the pandemic (oxygen supplementation post vs. pre: 59.4% vs. 54.8%, p < 0.001, non-invasive ventilation post vs. pre: 12.4% vs. 7.2%; p < 0.001). No deaths occurred during the entire observational period.</p><p><strong>Conclusion: </strong>We present comprehensive data on distinct seasonality and increased disease severity in children hospitalized with RSV bronchiolitis before and after the onset of the SARS-CoV-2 pandemic. Our data aids in understanding the impact of the pandemic on RSV disease in infants and provides valuable information on the impact of RSV on pediatric healthcare prior to broad introduction of novel prevention measures such as nirsevimab.</p><p><strong>What is known: </strong>• Respiratory syncytial virus (RSV) is a leading cause of infant morbidity and mortality globally. • COVID-19 has led to significant shifts in RSV seasonality, and concerns about shifts in RSV severity.</p><p><strong>What is new: </strong>• This study shows distinct seasonality and significant shifts in diseases severity amongst children with RSV associated hospitalization under the age of 2 yrs in the last years in Germany. • It reports significantly higher rates of RSV associated respiratory failures in children < 2 yrs. of age after emergence of the pandemic.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"246"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A global cross-sectional survey on neonatal analgosedation: unveiling global trends and challenges through latent class analysis.","authors":"Cristina Arribas, Giacomo Cavallaro, Nunzia Decembrino, Juan Luis González, Carolina Lagares, Genny Raffaeli, Anne Smits, Sinno P H Simons, Eduardo Villamor, Karel Allegaert, Felipe Garrido","doi":"10.1007/s00431-025-06074-z","DOIUrl":"10.1007/s00431-025-06074-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to analyze global prescribing patterns for analgosedation in neonates during four critical care scenarios. The research explores existing patterns, their association with geographic and sociodemographic index (SDI), and adherence to evidence-based practices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data from a 2024 global survey of 924 responses to 28 questions were analyzed, focusing on four items for their high variability: premedication in intubation (Q17), sedation in preterm (Q19) and full-term newborns (Q23), and perinatal asphyxia (Q26). Latent class analysis (LCA) classified neonatal intensive care unit (NICU) prescriptions into patterns, assigning participants to the most likely class. Demographic variables, including geographic region and SDI, were compared using chi-square tests to assess associations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three distinct prescribing patterns emerged for each scenario. In premedication during intubation, Europe and North America predominantly used Class 1, adhering to guidelines with fentanyl, atropine, and muscle relaxants. In contrast, Class 2, standard in Asia and Latin America-Caribbean, primarily utilized fentanyl and midazolam, with rare use of atropine and muscle relaxants. For analgosedation in newborns, higher-SDI NICUs favored fentanyl, while lower-SDI NICUs preferred midazolam or morphine combinations. In perinatal asphyxia cases, fentanyl was the leading choice in Class 3, especially in Europe. Dexmedetomidine use was limited, primarily appearing in Class 1 NICUs.  CONCLUSION: The study highlights substantial regional variability in neonatal analgosedation, influenced by SDI and geography. Despite established guidelines, gaps in evidence-based implementation persist. These findings underscore the need for global standardization of neonatal care protocols and further research on the long-term safety of midazolam and dexmedetomidine.  What is Known: • Previous research has demonstrated significant disparities in prescribing patterns for neonatal analgosedation across geographic areas influenced by demographic and socioeconomic factors. • Midazolam remains a commonly utilized agent in neonatal analgosedation despite evidence suggesting potential neurodevelopmental risks, particularly in premature infants. • Current guidelines regarding neonatal analgesia and sedation, including premedication for endotracheal intubation, are not consistently implemented, particularly in regions characterized by lower sociodemographic indices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is new: &lt;/strong&gt;• This study employs Latent Class Analysis (LCA) to categorize global neonatal prescribing practices into three distinct patterns, elucidating regional differences and compliance with evidence-based guidelines. • Care providers working in countries with higher Sociodemographic Index (SDI) are more likely to adhere to evidence-based practices, such as intubation premedication, than regions with medium or mediu","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"241"},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of asymmetric dimethyl arginine level in pediatric patients with COVID-19 infection and MIS-C.","authors":"Memduha Sari, Fatih Akin, Abdullah Yazar, Ahmet Osman Kilic, Ozge Metin Akcan, Abdullah Akkus, Mehmet Uyar, Cemile Topcu, Mustafa Genceli","doi":"10.1007/s00431-025-06079-8","DOIUrl":"10.1007/s00431-025-06079-8","url":null,"abstract":"<p><p>Coronavirus disease 2019 (COVID-19) and COVID-19-related multisystem inflammatory syndrome in children (MIS-C) is known to be a life-threatening health problem worldwide. The study investigates the potential relationship between asymmetric dimethylarginine (ADMA) levels and disease severity in such conditions. We conducted an observational, prospective study between July 2021 and January 2022. The study enrolled 98 patients diagnosed with COVID-19, 21 patients diagnosed with MIS-C, and 42 healthy individuals who served as a control group. The COVID-19 patients were further categorized into three subgroups based on their level of care: outpatients, those requiring hospitalization, and those requiring intensive care. The MIS-C patients formed a distinct fourth group. COVID-19 outpatients had a median ADMA level of 8097.0 ng/L (interquartile range: 6436.06-10840.0 ng/L), while those requiring hospitalization had a higher level of 13,195.60 ng/L (11,472.4-15,862.2 ng/L). Patients in intensive care exhibited the highest median ADMA level at 19,361.4 ng/L (15,596.65-23,367.9 ng/L). MIS-C patients also had elevated ADMA levels, with a median of 15,735.50 ng/L (13,486.6-20,532.5 ng/L). Receiver operating characteristic (ROC) curve analysis revealed that an ADMA level of 6135.15 ng/L could distinguish between patients and controls with 95% sensitivity, 100% specificity, 100% positive predictive value, and 87.5% negative predictive value.</p><p><strong>Conclusions: </strong>In conclusion, our study is the first to investigate ADMA levels in children with COVID-19 and MIS-C. We found that ADMA levels were significantly elevated in children with COVID-19 requiring intensive care and those with MIS-C, suggesting a potential role for ADMA as a biomarker of endothelial dysfunction in these populations.</p><p><strong>What is known: </strong>• Endothelial dysfunction is a determinant of poor prognosis in various cardiovascular diseases and plays a critical role in the pathogenesis of COVID-19 and MIS-C. • Asymmetric dimethylarginine (ADMA) is a well-known biomarker of endothelial dysfunction. Elevated levels of ADMA adversely affect vascular endothelial function by reducing nitric oxide production.</p><p><strong>What is new: </strong>• It is the first to show that elevated ADMA levels in children with COVID-19 and MIS-C are associated with disease severity. • ADMA has been identified as a potential biomarker that can be used to assess the prognosis of COVID-19 and MIS-C in children and to predict the severity of the disease.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"242"},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can prenatal conditions impact the effect of omega-3 on bronchopulmonary dysplasia in very preterm infants? A secondary analysis of a randomized controlled trial.","authors":"Hymel Rais, Etienne Pronovost, Mireille Guillot, Amélie Boutin, David Simonyan, Ibrahim Mohamed, Pascal M Lavoie, Bruno Piedboeuf, Isabelle Marc","doi":"10.1007/s00431-025-06053-4","DOIUrl":"https://doi.org/10.1007/s00431-025-06053-4","url":null,"abstract":"<p><p>To explore whether prenatal conditions (i.e. chorioamnionitis, preeclampsia or small-for-gestational age (SGA)) affect the very preterm infant's response to docosahexaenoic acid (DHA) on bronchopulmonary dysplasia (BPD), according to mode of delivery, an independent factor shown to modulate this association. Secondary exploratory analysis of the MOBYDIck randomized controlled trial (NCT02371460) evaluating the effect of a neonatal high-dose DHA supplementation through maternal breastmilk compared to placebo. Population was preterm infants born before 29 weeks of gestation in sixteen Canadian neonatal intensive care units. Primary outcome was physiological BPD based on pulse oximetry assessment. Secondary outcomes included \"death or BPD\"; \"moderate-or-severe\" BPD; severe BPD; death from any causes. Heterogeneity in the effect of DHA on outcomes was assessed by prenatal conditions and mode of delivery using generalized estimating equation logistic regression models. The trial intended to enroll 800 mothers but was stopped early for safety, likely making subgroup analysis underpowered. 230 mothers (271 infants) were included in DHA group and 226 mothers (252 infants) in placebo group. The association between high-dose DHA and BPD differed by chorioamnionitis status (heterogeneity P=0.04). In infants exposed to chorioamnionitis and vaginal delivery, DHA supplementation was associated with a reduced risk of physiological BPD (adjusted odds ratio, 0.18 [95% CI, 0.05 to 0.62], P=0.007). No heterogeneity was found by maternal preeclampsia (heterogeneity P=0.44) nor SGA status (heterogeneity P=0.17).</p><p><strong>Conclusion: </strong>This secondary analysis generated hypotheses for a potential differential effect of neonatal enteral high-dose DHA supplementation on BPD in very preterm infants according to chorioamnionitis exposure.</p><p><strong>What is known: </strong>• The MOBYDIck trial reported a potential protective effect of docosahexaenoic acid (DHA) supplementation on bronchopulmonary dysplasia (BPD) in infants born vaginally, but not in those born via cesarean section. • Placenta pathologies are associated with inflammation in the infants and could affect the very preterm infant's response to a high-dose DHA supplementation on BPD according to the mode of delivery.</p><p><strong>What is new: </strong>• This study suggests that, in infants born very preterm before 29 weeks of gestation, the association between enteral high-dose DHA supplementation in neonatal period and BPD at 36 weeks' postmenstrual age differ according to the maternal status for chorioamnionitis at delivery.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"243"},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From bedside vigilance to empowered parent: a descriptive qualitative study of maternal involvement in the pediatric intensive care unit.","authors":"Selecia Gwee Lee En, Pei Fen Poh, Qian Wen Sng, Shuen Hwee, Jamie Qiao Xin Ng, Shefaly Shorey","doi":"10.1007/s00431-025-06083-y","DOIUrl":"https://doi.org/10.1007/s00431-025-06083-y","url":null,"abstract":"<p><p>To explore the experiences of mothers of children hospitalized in the Pediatric Intensive Care Unit (PICU) and the factors influencing their involvement in Singapore.Convenience sampling was used to recruit mothers of children aged 0 to 18 years old hospitalized in a PICU for at least 48 h from a public tertiary hospital in Singapore from September to November 2023. Semi-structured interviews were conducted with 13 mothers in person until data saturation was achieved. Thereafter, data were analyzed using thematic analysis. Four themes and thirteen subthemes were identified. The themes were: (1) Emotional roller-coaster, (2) Redefining mother's duties, (3) Collaborating with the healthcare team, (4) Barriers to Maternal Involvement. Conclusions: Mothers felt hopeless and anxious during their child's hospitalization but rarely showed outward signs of emotional distress. Mothers were motivated to be involved in caregiving activities by their desire to reclaim their maternal role. Mothers worked closely together with the healthcare providers. However, maternal involvement was limited by their fear of causing more harm, inconducive spaces, and balancing their sick child and other siblings at home. These findings provide a nuanced insight into maternal experiences and can help to inform enhanced family-centered care hospital policies. Triangulation of findings from PICU healthcare providers and other caregivers such as fathers and siblings is needed to holistically understand the support needs of such families. Practice implications: PICU healthcare providers need to pay greater attention to maternal emotional well-being. After more research on families with children in PICU, hospitals could seek to implement family-centred psychosocial support programs for parents and siblings.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"245"},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Development and external validation of a Nomogram to predict obstructive sleep apnea in Children.","authors":"Yuqi Yuan, Lina Ma, Huanhuan Chang, Yonglong Su, Simin Zhu, Yanuo Zhou, Zitong Wang, Zine Cao, Liang Xing, Xiaoxin Niu, Yushan Xie, Zihan Xia, Yitong Zhang, Haiqin Liu, Yani Feng, Juan Hu, Xiaoyong Ren, Yewen Shi","doi":"10.1007/s00431-025-05973-5","DOIUrl":"10.1007/s00431-025-05973-5","url":null,"abstract":"","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"244"},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning approach to predict mortality and neonatal persistent pulmonary hypertension in newborns with congenital diaphragmatic hernia. A retrospective observational cohort study.","authors":"Luana Conte, Ilaria Amodeo, Giorgio De Nunzio, Genny Raffaeli, Irene Borzani, Nicola Persico, Alice Griggio, Giuseppe Como, Mariarosa Colnaghi, Monica Fumagalli, Donato Cascio, Giacomo Cavallaro","doi":"10.1007/s00431-025-06073-0","DOIUrl":"10.1007/s00431-025-06073-0","url":null,"abstract":"<p><p>Congenital diaphragmatic hernia (CDH) has high morbidity and mortality rates. This study aimed to develop a machine learning (ML) algorithm to predict outcomes based on prenatal and early postnatal data. This retrospective observational cohort study involved infants with left-sided CDH, born from 2012 to 2020. We analyzed clinical and imaging data using three classification algorithms: XGBoost, Support Vector Machine, and K-Nearest Neighbors. Medical records of 165 pregnant women with CDH fetal diagnosis were reviewed. According to inclusion criteria, 50 infants with isolated left-sided CDH were enrolled. The mean o/eLHR was 37.32%, and the average gestational age at delivery was 36.5 weeks. Among these infants, 26 (52%) had severe persistent neonatal pulmonary hypertension (PPHN), while 24 (48%) had moderate or mild form; 37 survived (74%), and 13 did not (26%). The XGBoost model achieved 88% accuracy and 95% sensitivity for predicting mortality using ten features and 82% accuracy for PPHN severity with 14 features. The area under the ROC curve was 0.87 for mortality and 0.82 for PPHN severity.</p><p><strong>Conclusion: </strong>ML models show promise in predicting CDH outcomes and supporting clinical decisions. Future research should focus on more extensive studies to refine these algorithms and improve care management.</p><p><strong>Clinical trial registration: </strong>NCT04609163.</p><p><strong>What is known: </strong>• Congenital diaphragmatic hernia (CDH) is a serious condition characterized by high morbidity and mortality rates, making it critical to predict neonatal outcomes for effective clinical management accurately. • Traditional prenatal diagnostic methods often struggle to predict complications such as Neonatal Persistent Pulmonary Hypertension (PPHN) in CDH, highlighting the need for innovative predictive approaches.</p><p><strong>What is new: </strong>• Machine learning (ML) models, particularly XGBoost, have been shown to accurately forecast mortality and the severity of PPHN in infants with CDH based on prenatal and early postnatal clinical and imaging data. • ML-based predictive models can enhance prenatal counseling, optimize birth planning, and tailor postnatal care for patients with CDH, enabling real-time risk assessment and adaptive management strategies.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"238"},"PeriodicalIF":3.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic device usage pattern is associated with sleep disturbances in adolescents: a latent class analysis.","authors":"Qian-Wen Lin, Shu-Han Wei, Yong-Xi Wu, Shi-Chao Wei, Yi-Qi Lin","doi":"10.1007/s00431-025-06065-0","DOIUrl":"https://doi.org/10.1007/s00431-025-06065-0","url":null,"abstract":"<p><p>This study aimed to identify individual differences in adolescents' electronic device usage patterns and explore their unique associations with sleep disturbances. From May to June 2019, students from 18 middle schools in Fuzhou were invited to fill out questionnaires about sleep health and electronic device usage, including screen time, usage timing, usage purpose, pre-sleep usage, and the presence of devices in bedrooms. Latent class analysis was employed to identify distinct usage patterns, and their associations with sleep disturbances were subsequently explored. Four usage patterns were identified among a total of 19,229 adolescents: (1) \"minor exposure-learning,\" (2) \"weekends dominance-game playing,\" (3) \"weekends and pre-sleep dominance-learning,\" and (4) \"excessive exposure-game playing.\" Compared to Pattern 1, a higher likelihood of insufficient sleep was found during weekdays and weekends in Pattern 3 (weekdays-odds ratio (OR) 1.15, 95% confidential interval (CI) 1.0-1.28; weekends-OR 1.19, 95% CI 1.09-1.30) and Pattern 4 (weekdays-OR = 1.48, 95% CI 1.31-1.68; weekends-OR = 1.40, 95% CI 1.27-1.53) but only during weekends in Pattern 2 (OR = 1.18, 95% CI 1.07-1.30). Besides, Patterns 2-4 were related to delayed bedtime, insomnia symptoms, and recurrent sleep paralysis or nightmares.</p><p><strong>Conclusion: </strong>Four electronic device usage patterns were found among adolescents. Compared with the pattern of minimal screen exposure and a learning purpose, other patterns were more likely to be associated with sleep disturbances. These findings carry significant implications for healthy electronic device usage and potential strategies to improve adolescents' sleep health.</p><p><strong>What is known: </strong>• As screen use among adolescents increases, promoting healthy digital habits is crucial for reducing sleep disruptions and enhancing well - being. • Existing recommendations on adolescents' electronic device use mainly focus on usage duration and lack systematic advice.</p><p><strong>What is new: </strong>• Latent class analysis (LCA) identified four electronic device usage patterns among Chinese adolescents, based on screen time, usage timing, purpose, pre-sleep usage, and device presence in bedrooms. • Reducing usage, especially pre-bedtime, using devices for education, and keeping them out of the bedroom were less linked to sleep issues.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 4","pages":"237"},"PeriodicalIF":3.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}